Amidst the avalanche of conversation about health policy during the long 2012 presidential process, one event, the September 11 2011 Republican Presidential Primary debate, stands out to me:
CNN moderator Wolf Blitzer's hypothetical question about whether an uninsured 30-year-old working man in coma should be treated prompted one of the most boisterous moments of audience participation in the CNN/Tea Party Express.
"What he should do is whatever he wants to do and assume responsibility for himself," Paul responded, adding, "That's what freedom is all about, taking your own risk. This whole idea that you have to compare and take care of everybody."
The audience erupted into cheers, cutting off the Congressman's sentence.
After a pause, Blitzer followed up by asking "Congressman, are you saying that society should just let him die," to which a small number of audience members shouted "Yeah!"
Par for the course for libertarian Ron Paul. What struck me was Mitt Romney standing speechless with the others. He could not lift a rhetorical pinky in the young man's behalf because it would set him apart from his competitors by looking compassionate.
Fast forward to Mitt Romney's September 23, 2012 CBS news interview:
QUESTION: Does the government have a responsibility to provide health care to the 50 million Americans who don't have it today?
ROMNEY: Well, we do provide care for people who don't have insurance, people -- we -- if someone has a heart attack, they don't sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care.
When Mitt Romney promoted the health reform law he signed as Massachusetts Governor on April 12, 2006, he most often invoked the need to stop using ERs as the source of care for the uninsured.
What a weird journey it has been. Not long ago, most Republican officials embraced the need for universal health coverage, just not the way Democrats wanted it through explicit government coverage. I saw this when I worked on the ACA in the U.S. Senate between 2008 and 2010, as many Republicans, including at least 8 who signed onto Senator Ron Wyden's (D-OR) universal coverage legislation, and many others, concurred. I sat in a room in June 2008 and heard Texas Senator Kay Bailey Hutchinson say: "We all agree that doing nothing is not an option."
Over the course of 2009, just about every elected Republican on Capitol Hill not only rejected the Democrats' health reform agenda, they explicitly rejected the notion of universal health insurance for all Americans. The U.S.A. is the only one of the top 25 advanced nations on our planet that does not have a structure to guarantee health security for all our citizens -- if this is what is meant by "American exceptionalism," you can have it.
And then there's Mitt, perhaps the last Republican to fall in line and reject the Republican innovation he spear-headed as Massachusetts Governor. With his CBS interview, it's all done. There's nothing left of that guy who stood on the stage in Faneuil Hall in Boston.
Instead, when it comes to the future of U.S. health policy, we have the most backward looking Republican Party nominee since Barry Goldwater in 1964. Let's look at particulars:
The Affordable Care Act (ACA/ObamaCare): I'll talk more about the ACA in my next closing argument on President Obama. The ACA is the only comprehensive health reform law ever enacted in U.S. history. Full of flaws far outweighed by its striking advances and innovations, repeal would set back the U.S. health system for generation or more -- on coverage, Medicare, Medicaid, delivery system reform, public health and prevention, workforce, fraud and abuse, biologics, and so much else. Romney has said "repeal and replace" more times than one can count. Two and one half years later, "replace" is a blank slate, and his website health reform agenda is a pathetic joke.
Medicare: Romney has repeatedly distorted the $716 billion in ACA Medicare savings to claim falsely that it would harm current Medicare enrollees. The only real harm to enrollees would happen with repeal, as they would lose new ACA benefits such as closing the prescription drug doughnut hole, and as they would see their Part B premiums rise immediately because of Romney's determination to give back the $716 billion in reductions to insurance companies and hospitals. The ACA pushed back the depletion of the Medicare Trust Fund from 2016 to 2024, and Romney's plan would reverse that progress, guaranteeing a Medicare financing crisis no later than 2016, something no Medicare enrollee should desire.
Romney's embrace of Paul Ryan?s voucher/premium support plan reflects the longtime Republican desire to eliminate the direct government Medicare benefit preferred by 70% of Medicare enrollees, even though the current private insurance model, Medicare Advantage, costs more than traditional Medicare. Romney's Medicare agenda is bankrupt and bankrupting one for Medicare and for America.
Medicaid: Republicans regularly talk about the horrors of Medicaid, and even declare that it's better to be uninsured than on Medicaid. What they never do it offer a counter vision to provide coverage for lower income Americans who make up the largest proportion of our nation's uninsured. They throw stones at Medicaid and then run for cover, and never taking responsibility to advance a real alternative. And they can't, because any alternative they name is going to cost a lot more than Medicaid, and they have no desire to spend any money on health care for disadvantaged low income Americans.
Women's Health: Since they claimed control of the House of Representative in 2011, the Republican Party has made restricting abortion one of its top legislative priorities. Mitt Romney says he has "no plans" to promote legislation to restrict abortion. He would not have to. The House Republicans will do it for him. And if any of those restrictions get through the Senate, he just has to sign. Also, he would not have to allow employers to restrict access to contraceptive coverage, because by repealing the ACA, there would be no federal requirement that such coverage be included in anyone's health plan.
Essential Federal Health Functions: The federal government does many critically important jobs to protect the health of the American public. None of these has been talked about during the presidential campaign or mentioned by Romney. The National Institutes of Health is the essential promoter of health innovation and discovery in the U.S. and the world, bar none; the Centers for Disease Control and Prevention is the vital protector of American and global health whenever there is a disease outbreak; the Food & Drug Administration protects our food and pharmaceutical supplies; on and on. Mitt Romney's tax and budget agenda -- if implemented -- would require cuts in all these key government functions by up to 60% to finance his agenda for tax cuts and defense spending increases.
It's hard to imagine these draconian and fool-hardy plans ever being implemented. Yet those are the clear results of Romney and Ryan's agenda.
I close with a gripe. Twice recently, on Meet the Press in September and in the first Presidential debate in early October, Mitt Romney said plainly that he would protect Americans with pre-existing conditions. Immediately thereafter, his handlers told the media that Romney only meant individuals who have continuous coverage -- a protection already guaranteed under a 1996 federal law known as the Health Insurance Portability and Accountability Act (HIPAA). The other day, I heard Romney in a speech again say he would protect all Americans from pre-existing condition exclusions. No clarity, no shame -- this is dishonesty.
Mitt Romney -- a bad choice for America's health.
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